Provider Demographics
NPI:1164013702
Name:CONCORDIA OF FLORIDA, INC.
Entity Type:Organization
Organization Name:CONCORDIA OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-352-1571
Mailing Address - Street 1:4100 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4864
Mailing Address - Country:US
Mailing Address - Phone:813-977-4950
Mailing Address - Fax:813-632-2456
Practice Address - Street 1:4100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4864
Practice Address - Country:US
Practice Address - Phone:813-977-4950
Practice Address - Fax:813-632-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility